Register Online

We are currently accepting application forms for the 2019 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us at 501-217-0053 or [email protected]

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile
 
Name
Last
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

 

Parent Information
 
Address
City/Zip
Phone
Email Address
Father's Name
Father's Cell
Mother's Name
Mother's Cell

 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number

 

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!

 

Pay Online
Please register my child for

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First Name
Last Name
Address
City
State
Zip
Amount $
Card Number
Card Type
Exp. Date
CVV Security Code